Egypt has the highest hepatitis C prevalence worldwide [
85], mostly attributable to transmission through injections to treat schistosomiasis between the 1950s and 1980s [
85]. In 2008, an estimated 9.8% of Egypt’s population aged 15–59 years was hepatitis C positive; prevalence was highest among those aged 50–59 [
86]. In 2015, the estimated prevalence among those aged 15–59 years declined to 7.0% [
87], predominantly due to ageing of the population with hepatitis C [
88,
89].
In 2006, the National Committee for Control of Viral Hepatitis was established to measure hepatitis C burden and prepare a national treatment programme [
90] and, in 2014, a national plan for prevention, control and treatment of viral hepatitis was released. The National Committee for Control of Viral Hepatitis and the Health Insurance Organization set up 189 government treatment facilities and created a national online database to register patients [
91]. Importantly, the Egyptian government rejected patent applications for sofosbuvir, enabling local production and supply of generics [
92]. In 2014, Egypt had a limited supply of branded sofosbuvir, which cost US$ 900 for a 12-week treatment course – still expensive relative to Egypt’s financial resources [
91]. Treatment was restricted to patients with advanced fibrosis, hepatitis B or HIV co-infection, and post-liver transplants, leading to long waiting lists [
91]. Subsequently, negotiations and generic production reduced prices significantly and DAAs became available to all patients [
91]. Between October 2014 and December 2017, 1.4 million patients commenced treatment, with cure rates above 90% [
91]. Because there are no compound patents on sofosbuvir and daclatasvir in Egypt [
93], treatment is now available for US$ 84 per treatment course from generic manufacturers [
21]. In 2016, the Ministry of Health established the Viral Hepatitis Control Administration, aiming to reduce new infections, screen 10 million people, eliminate waiting lists and enhance their sentinel surveillance systems [
94]. Despite high hepatitis C prevalence, Egypt is on track to achieve WHO elimination targets [
1].